DEAR MAYO CLINIC: My friend was recently diagnosed with leukemia, and I've learned there are several types. How do these differences affect her treatment options and decisions? 

ANSWER: It's true — leukemia isn't a single disease. It's a group of blood cancers, and the exact type plays a major role in how it's treated. Understanding these differences can help patients and families feel more informed and prepared. 

Leukemia is a cancer of the blood and bone marrow, where blood cells are made. Unlike cancers that start in one organ and spread, leukemia is usually considered a whole-body, or systemic, disease right from the beginning. 

In leukemia, the bone marrow produces abnormal white blood cells. These cells don't work properly and can crowd out healthy cells. This can lead to: 

• Fatigue and weakness (from low red blood cells). 

• Easy bruising or bleeding (from low platelets). 

• Frequent infections (from a weakened immune system). 

• Shortness of breath. 

• Bone pain or tenderness. 

• Swollen lymph nodes. 

• Enlarged liver or spleen. 

• Fever or chills. 

• Unintentional weight loss.  

Patients may overlook early leukemia symptoms because they may resemble symptoms of the flu and other common illnesses. 

Types of leukemia

There are four main types of leukemia: 

• Acute lymphocytic leukemia (ALL), which is the most common type of leukemia in young children, but it can also occur in adults. 

• Acute myeloid leukemia (AML), which is the most common type of acute leukemia in adults. 

• Chronic lymphocytic leukemia (CLL), which is the most common chronic leukemia in older adults. 

• Chronic myeloid leukemia (CML), which mainly affects adults of various ages. 

They're grouped based on how fast they grow and the type of blood cell involved:  

• Acute leukemias develop quickly and need urgent treatment. 

• Chronic leukemias grow more slowly and may not need treatment right away. 

• Lymphocytic leukemias affect lymphocytes, a type of white blood cell involved in the immune system.  

• Myeloid leukemias affect cells that develop into red blood cells, platelets and other types of white blood cells.  

Each type — and even subtypes within them — can behave quite differently. For example, some people may have a slow-growing form of CLL that may not need treatment for years, while others may have a faster-growing subtype that requires treatment soon after diagnosis. 

Diagnosis

Diagnosis often begins with a routine blood test that shows abnormal cell counts. If leukemia is suspected, a bone marrow biopsy — taking a small sample from the hip bone — is usually needed to confirm the diagnosis. From there, more detailed testing is done, including: 

• Flow cytometry to identify cell types. 

• Cytogenetics to study chromosomes. 

• Molecular testing to look for genetic changes. 

Accurate diagnosis is essential because different types of leukemia require different treatments. Some therapies work only for certain genetic markers, and the expected outcome can vary widely. These tests allow doctors to match patients with therapies that target their specific disease, making leukemia treatment highly individualized.  

Treatment

Treatment may include: 

• Chemotherapy, a drug treatment that uses powerful chemicals to kill fast-growing cells in your body. 

• Targeted therapy, a treatment that uses medicines that attack specific targets in the cancer cells.  

• Immunotherapy, treatments that help the immune system fight cancer. These include CAR-T cell therapy — engineered immune cells that attack cancer cells — and bispecific antibodies that help immune cells find cancer cells. 

• Stem cell transplantation, a treatment that replaces diseased bone marrow with healthy cells, often using donor cells. 

When deciding the best treatment, doctors consider several factors, including: 

• The exact type and subtype of leukemia. 

• Genetic and molecular test results. 

• How quickly the disease is progressing. 

• The patient's age and overall health. 

• The patient's personal preferences. 

The future of leukemia treatment is focused on precision medicine — tailoring treatments to the genetic makeup of each patient's leukemia — and improving long-term outcomes with fewer side effects. With advances in testing and therapy, care is becoming more personalized than ever, offering hope for even better results in the coming years.  

William Hogan, M.B., B.Ch., Hematology, Mayo Clinic, Rochester, Minnesota 

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PHOENIX — A Mayo Clinic-led international phase 3 study found that a new immunotherapy helped many patients with an aggressive form of bladder cancer keep their bladder instead of having it surgically removed. The treatment also kept many patients cancer-free for more than two years and caused mostly mild side effects. The findings were published in The Lancet Oncology.

Patients in the study had high-risk bladder cancer that had returned despite standard treatment with bacillus Calmette-Guérin (BCG). For these patients, surgery to remove the bladder is typically the recommended next step. The new immunotherapy treatment, called cretostimogene grenadenorepvec, produced a complete response, with no detectable signs of cancer in 75% of patients, with many of those responses lasting beyond two years.

"Until now, patients whose cancer returned after BCG therapy have had few effective options besides bladder removal," says Mark Tyson II, M.D., lead author of the study and a urologist at Mayo Clinic in Arizona. "This study shows we may be able to offer many of those patients another option without compromising cancer control."

Among patients whose cancer completely disappeared after treatment, about 60% remained cancer-free two years later. In one patient, the cancer has not returned for more than four years after completing treatment. Most treatment-related side effects were mild, temporary bladder symptoms, and researchers reported no severe treatment-related side effects.

"For patients, this isn't just about treating cancer — it's about preserving quality of life," says Dr. Tyson. "Avoiding bladder removal can have a profound impact on daily living. Seeing patients remain cancer-free for years while keeping their bladder is exactly the outcome we've been hoping to achieve."

The study included 115 patients treated at 41 medical centers across North America, Asia and Australia. Two years after starting treatment, an estimated 81% of patients had not needed surgery to remove their bladder. The researchers concluded that cretostimogene grenadenorepvec could become an important bladder-sparing treatment option for patients whose high-risk bladder cancer has returned after standard BCG therapy. They also noted that the treatment has not been directly compared with other bladder-sparing therapies in clinical trials.

The study was funded by CG Oncology. For a complete list of authors, disclosures and funding, review the study. The therapy remains investigational.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Julie Ferris-Tillman, Ph.D., Mayo Clinic Communications, newsbureau@mayo.edu

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DEAR MAYO CLINIC: My neighbor recently had an X-ray after hurting their leg, and the doctor found a bone lesion that needs more testing. They're terrified it could mean bone cancer. It got me wondering: Does every bone tumor or bone lesion mean cancer?  

ANSWER: Hearing that an imaging test found a bone tumor or bone lesion can be frightening. Fortunately, most bone tumors aren’t cancerous. The key is finding out exactly what type of tumor or lesion you have, so your healthcare team can recommend the right care. 

A bone tumor is an abnormal growth of cells within the bone. Some bone tumors are benign (noncancerous) and may simply be monitored over time. Others are malignant (cancerous) and require treatment because they can grow, damage the bone or spread to other parts of the body.  

It's also important to understand that primary bone cancer is different from cancer that has spread to the bone from another part of the body. Cancers are named for where they begin. For example, if lung cancer spreads to the bone, it's still lung cancer, not bone cancer. Likewise, if bone cancer spreads to the lungs, it's still bone cancer.  

Knowing where a cancer began helps your healthcare team recommend the most appropriate treatment. Primary bone cancers are also usually not caused by something you did or didn't do, which can be reassuring to know. 

Pain in your bones, muscles or joints is common and is usually caused by conditions other than cancer. However, pain that continues to worsen, doesn't improve over time, wakes you from sleep or is associated with other symptoms, such as swelling, fever, weight loss or limping, deserves medical evaluation. 

In children and teenagers, persistent pain shouldn't automatically be dismissed as growing pains. While growing pains are common, ongoing pain that interferes with sports, school or daily activities should be evaluated by a healthcare professional.  

Persistent back pain in children is also uncommon and should be checked. Another warning sign is a fracture that occurs after little or no trauma. Some bone tumors can weaken the bone enough that it breaks more easily than expected. 

Sometimes bone tumors don't cause symptoms at all. Instead, they’re discovered when an X-ray or other imaging test is performed after a sports injury or another unrelated problem. In these situations, the injury didn't cause the tumor; the imaging simply revealed something that was already there. 

When a bone tumor or lesion is found, your healthcare team will review your medical history, perform a physical examination and determine whether additional imaging, such as a CT scan or MRI, is needed to better understand the abnormality. Based on those imaging findings, a biopsy may be recommended. 

During a biopsy, a small tissue sample is removed and examined under a microscope to determine exactly what type of cells are present. The biopsy results help your healthcare team make an accurate diagnosis and recommend the most appropriate treatment. Waiting for answers can be difficult, but taking the time to make an accurate diagnosis helps ensure you receive the most appropriate treatment. 

Treatment depends on the type of bone tumor. Many benign tumors don't require treatment and can simply be monitored if they're not causing pain, limiting function or weakening the bone. Other benign bone tumors may require surgery. Malignant bone tumors, however, require treatment. Depending on the type of cancer, treatment may include surgery, chemotherapy, radiation therapy or a combination of these approaches. 

Because bone tumors are rare, it's important to be evaluated by a healthcare team with experience diagnosing and treating your specific condition. Specialists, including radiologists, pathologists, orthopedic surgeons and medical oncologists, work together to make an accurate diagnosis and recommend the most appropriate treatment plan. 

If you've been told you have a bone tumor or bone lesion, try not to assume the worst. Many bone tumors are benign, and even malignant bone cancers can often be treated successfully. If you have persistent pain, an abnormal imaging finding or symptoms that concern you, don't ignore them. Talk with your healthcare team. An accurate diagnosis is the first step toward getting the care that's right for you. 

Wendy Allen-Rhoades, M.D., Ph.D., Oncology, Mayo Clinic, Rochester, Minnesota

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Mayo Clinic oncologist explains risk factors, treatment considerations for patients under 50

PHOENIX — You may have heard that colorectal cancer is increasingly affecting young adults. However, it is not the only gastrointestinal (GI) cancer that doctors are diagnosing in patients below the age of 50, explains Christina Wu, M.D., an oncologist at Mayo Clinic Comprehensive Cancer Center in Arizona.

"People under 50 are not too young to develop gastrointestinal cancers," Dr. Wu says. "If young adults notice new or persistent symptoms, it's important to get them worked up."

At Mayo Clinic, early-onset gastrointestinal cancers are defined as GI cancers diagnosed in people under 50 years old. Research shows that the most common type of early-onset GI cancer worldwide is colorectal cancer, followed by stomach cancer, esophageal cancer and pancreatic cancer. Less common types of early-onset GI cancers include bile duct, gallbladder, appendix, neuroendocrine and small bowel cancers.

"More research needs to be done to understand what causes the rise in incidence of early-onset GI cancers," Dr. Wu says. "We know that certain factors can increase the risk of developing GI cancers, and early detection gives patients a better chance of successful treatment."

Risk factors

Several factors can increase the risk of developing early-onset GI cancers, including genetic conditions, chronic diseases and lifestyle:

• Lynch syndrome and familial adenomatous polyposis are hereditary conditions that are associated with an increased risk of early-onset colorectal cancers.

• Inflammatory bowel disease and primary sclerosing cholangitis can increase the risk of developing GI cancers such as colorectal cancer and cholangiocarcinoma, respectively.

• A sedentary lifestyle, obesity, diets high in processed foods, alcohol consumption, smoking and environmental exposures may be associated with an increased risk of GI cancers.

Early detection and symptoms

Recommendations for when people at average risk for colorectal cancer should be screened vary by country but generally start in their 40s or early 50s. In the U.S., colorectal cancer screening is recommended to start at age 45 for people at average risk; people with risk factors such as a family history of colorectal cancer may need to start screening earlier.

Having a primary care clinician, getting regular health checkups and discussing any health concerns with a healthcare professional can help determine what screening or tests may be needed, depending on individual risk factors.

In some cases, symptoms of early-onset GI cancers may present and be associated with specific cancer types:

• Unintentional weight loss with jaundice and pain may indicate pancreatic cancer.
• Weight loss, pain, and difficulty eating or swallowing may be linked to stomach cancer.
• A persistent change in bowel habits, abdominal pain and iron-deficiency anemia may be associated with colorectal cancer.

"Any new symptoms that are persistent or worrisome should prompt a visit to a healthcare professional to get checked out," Dr. Wu says. "If symptoms are ignored or not investigated, young adults may experience a delay between when they first experience symptoms and a cancer diagnosis. Recognizing symptoms early is important," Dr. Wu explains.

Tailoring care for younger adults  

Young adults diagnosed with GI cancers often need multidisciplinary care due to differences in cancer biology, as well as unique social and life-stage needs.

"Before starting treatment, we perform genetic testing and tumor profiling to identify mutations that may guide targeted therapies," says Dr. Wu. "These advances allow us to provide more personalized and effective treatment for our patients."

In addition, young adults may require support, such as fertility preservation and resources to navigate the emotional and practical challenges of a cancer diagnosis. Mayo Clinic's Early-Onset and Hereditary GI Cancers Program provides specialized, multidisciplinary care for this patient population.

Innovations in treatment

With advances in genetic testing and tumor profiling, cancer care teams can provide more personalized and targeted treatments, including immunotherapy in some cases, and identify patients who may be eligible for clinical trials. Analysis of the tumor helps guide treatment decisions and identify appropriate therapies.

For certain GI cancers, treatment may involve a combination of chemotherapy, radiation (including proton beam therapy) and surgery. Advances in treatment, including minimally invasive approaches and immunotherapy, are improving care for some GI cancers.

Mayo Clinic researchers have been exploring the use of artificial intelligence as an additional aid in the detection of gastrointestinal cancers such as colorectal cancer and pancreatic cancer.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Caroline Auger, Mayo Clinic Communications, newsbureau@mayo.edu

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After receiving a serious diagnosis, one patient turned to several medical institutions in search of answers. Where other institutions saw limitations, Mayo Clinic's interdisciplinary team saw a way forward. 

When Kyle Collett was diagnosed with an advanced tumor affecting approximately 65% of his tongue, life changed overnight.

 At 39 years old, he was a soon-to-be husband and a strategic finance professional.

"Like many people my age, cancer was simply not something I expected to hear," Kyle recalls. "My days were focused on building a future with my family, staying active and planning for what was ahead."

Before Kyle came to Mayo Clinic, the multiple medical opinions he had received had pointed toward a challenging future that included immediate major surgery, a near-total glossectomy (removal of most of the tongue), and a dramatically altered quality of life.

A different approach: Focus on what is possible

Where other institutions saw limitations, Mayo Clinic's interdisciplinary team saw an opportunity to help.

"This was a young patient," says Samip Patel, M.D., an otolaryngologist at Mayo Clinic and lead surgeon in Kyle's case. "He and his fiancée were really just starting their life together when he was diagnosed with a large oral tongue cancer."

"What was unique about this case was that we were able to pause as a multidisciplinary team and ask, 'Is there a way to treat this cancer effectively, but also preserve as much speech, swallowing and quality of life as possible?'"

Kyle quickly recognized that this collaborative team approach meant he was where he was supposed to be for his treatment.

"When nearly every other opinion focused on what I was going to lose, Mayo Clinic focused on what might still be possible," he says. "Rather than applying a one-size-fits-all approach, the team took the time to evaluate my unique situation and develop an individualized treatment plan."

Oral tongue cancers are aggressive, making cure the top priority. However, preserving the components of human identity, speech, swallowing and appearance matters tremendously.

Mayo Clinic overcame this challenge by bringing surgery, medical oncology, radiation oncology, radiology, pathology and therapy teams together early in Kyle's journey.

"Instead of feeling like I was navigating disconnected opinions, Mayo Clinic's teams functioned as one unified group with a shared mission," Kyle says.

Rather than immediate major surgery, Kyle's team recommended induction systemic therapy first. This treatment approach uses full-body medications like chemotherapy or immunotherapy to shrink the tumor and target hidden cancer cells before an operation.

"He had a strong response, and that allowed us to make the surgery smaller and then deliver more targeted postoperative radiation," Dr. Patel explains. "To me, that is the heart of personalized cancer care. The goal was to balance cure with long-term function."

By using neoadjuvant chemoimmunotherapy to shrink the tumor before surgery, the team spared Kyle from losing most of his tongue.

Kyle credits Dr. Patel's ability to explain complex medical information, alongside the commitment of the Radiation Oncology team.

Following surgery, a network of specialists, including speech, physical and lymphatic therapists, helped Kyle regain function and trained his fiancée to do Kyle's required home care.

Today, Kyle enjoys family dinners, travel and joyous conversations about what is next in life.

"The milestone was not just that the cancer was treated," says Dr. Patel. "It was that we were able to treat it in a way that helped protect his long-term function and quality of life. To me, that is real success, not just recovery from treatment, but recovery of life."

Providing confidence, clarity and hope

Dr. Patel notes that for complex head and neck cases, Mayo Clinic designs treatment around the whole person, not just the tumor.

Kyle praises that approach.

"The expertise is extraordinary, but what truly sets Mayo apart is the way it combines innovation, collaboration and humanity," he says. "During one of the most uncertain and frightening experiences of my life, Mayo Clinic gave me confidence, clarity and hope."

The post When others focused on loss, Mayo Clinic focused on possibility appeared first on Mayo Clinic News Network.

A tiny lung nodule can be difficult to find during surgery. Now, Mayo Clinic surgeons are using fluorescent imaging technology to help locate suspicious nodules with greater precision while preserving healthy lung tissue.

The imaging contrast substance is administered before surgery and travels through the body, binding to certain lung cancer cells. During the procedure, surgeons use a specialized camera to detect the fluorescent signal, causing the cancerous tissue to glow. This allows the surgical team to easily identify and remove targeted tissue.

Watch: The Mayo Clinic Minute

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"Using this fluorescent agent is really helpful because it hones to the cancer cells and binds to one of the receptors on cancer cells," says Dr. Jonathan D'Cunha, a Mayo Clinic cardiothoracic surgeon. "When you're in the operating room, you can use your advanced fluorescent imaging to see the tumor light up."

The technology can help surgeons identify tiny nodules that may be difficult to see or feel during minimally invasive procedures. It also helps distinguish cancerous tissue from healthy lung tissue, allowing for greater precision during surgery.

"We're always looking for tools to be more precise in what we do," says Dr. D'Cunha. "The earlier we can identify and resect, the better chances and better outcomes for patients."

Learn more: Mayo Clinic Lung Cancer Program

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After an exceptionally rare diagnosis, a lifesaving bone marrow transplant and a near-fatal infection that pushed his body to the brink, Mike Sonnabend is not only alive — he's back to doing what once seemed impossible. 

Mike Sonnabend, a husband and father to three sons, enjoys being active — not just physically but also in the Rochester, Minnesota, community. The special education teacher and head coach of cross-country and track was preparing for an adventurous Scouting trip to the Florida Keys with his oldest son, Sam, and needed to complete a physical as part of the trip requirements.  

During the exam, his Mayo Clinic family medicine physician, Dr. Lori Bates, noticed that his spleen felt enlarged. Mike didn't think anything of it — he was feeling fine and had no symptoms. But after undergoing several tests and a bone marrow biopsy before leaving for his trip, he had a feeling he would come back to bad news.  

He was right. On July 3, 2014, Mike was diagnosed with a serious and complex disease consisting of leukemia — a cancer of the body's blood-forming tissues, including the bone marrow and the lymphatic system — and a bone marrow failure disorder, where blood cells don't develop normally. It's an incredibly rare condition — with very few cases worldwide — and is incurable with standard treatments.  

Mike's hematologist, Dr. Mrinal Patnaik, explained that a bone marrow transplant, a procedure that infuses healthy blood-forming stem cells into the body to replace bone marrow that's not producing enough healthy blood cells, would be the most effective treatment.  

"I knew that I couldn't fight this on my own. My Mayo Clinic care team is the experts, so I let them take care of the fighting, and I focused on what I could control — my family, my mindset and my recovery." 

As news of Mike's diagnosis spread, his family, friends, colleagues and community members quickly rallied around him and offered support.  

A rare diagnosis becomes even more complex 

Mike was referred to Dr. Mithun Shah, a Mayo Clinic transplant hematologist to ensure he was physically prepared for the transplant.  

All was going well with Mike's pretransplant testing until a pulmonary function test showed his lung function was much lower than expected. Because bone marrow transplants involve extensive treatments with a long, complex recovery, unexplained lung issues could make the procedure too dangerous. 

"We have a rare disease, and now there is a unique lung presentation. Our culture of collaboration at Mayo Clinic is where we shine. I picked up the phone and called my colleagues in hematology, pulmonology, pathology and other specialties — and we worked together, in real time, to assess risks and adapt Mike's treatment plans," says Dr. Shah.  

Dr. Shah referred Mike to Dr. Vivek Iyer, a Mayo Clinic pulmonologist, to help diagnose and treat the lung problem.  

"Transplant patients often have complex medical issues affecting multiple organ systems, so different specialties often need to collaborate expeditiously to solve critical issues that could delay or even prevent a successful transplantation," says Dr. Iyer.  

A lung biopsy confirmed that Mike had eosinophilic pneumonia, a rare and serious inflammatory lung condition. When steroids failed to resolve it, Dr. Iyer prescribed a monoclonal antibody-based therapy typically used for severe asthma that stabilized his lungs and kept his transplant on track — until another barrier emerged: Mike's enlarged spleen began draining his energy and appetite. In December 2019, doctors removed the massive organ, allowing his care team to move forward with his carefully planned transplant approach that would treat his leukemia while protecting his lungs.  

It worked. Mike had a successful transplant in 2020.  

Driven by a mindset focused on progress, Mike was back to coaching, teaching and running within a time frame that was "absolutely incredible," according to Dr. Shah.  

"My approach was to take the next step, trust the process and keep moving forward," says Mike.  

That same resilience would become even more evident five years later, when his journey took another dramatic turn.  

From stability to a sudden, life-threatening turn 

It was April 14, 2025. Around mid-morning, Mike began to feel fatigued, feverish and disoriented. He left work early and went to lie down, setting an alarm so he could make it to track practice that afternoon.  

But Mike wasn't well enough to make it to practice. Sam, who coaches with his dad, remembers having a sinking feeling, especially because he hadn't heard from him.  

"My dad would never not show up without letting me or the other coaches know, let alone even miss a day," says Sam.  

Sam went home after practice to check on his dad. Mike had slept through his alarm, had a high fever and was disoriented. Sam and his mom took him to Mayo Clinic's Emergency Department.  

"I don’t remember much," says Mike. "I remember going to the emergency room, and then it went black." 

Doctors soon determined he was battling bacterial meningitis, an infection that triggered overwhelming sepsis. For transplant patients like Mike, whose immune systems are compromised and who no longer have a spleen, even common bacteria can become life-threatening. 

Within hours, multiple organs began failing. His kidneys shut down, his blood pressure crashed and his body's clotting system began breaking down. He was transferred to the intensive care unit (ICU), where his condition became so dire that his family was called in to prepare for the worst. 

Mike's care again became a full-scale, multidisciplinary effort. Specialists across Mayo Clinic mobilized simultaneously — including experts in critical care, infectious diseases, nephrology, transplant medicine, vascular medicine, rehabilitation and more, meeting in real time to exchange ideas and make quick decisions together. 

"Mayo Clinic’s team-based approach is critical in situations like this. We needed everyone's expertise to give Mike the best chance of survival," says Dr. Shah.  

For Mike and his family, that collaboration was visible every day. 

"There was so much brainpower in that room, you could almost feel it," Mike says. "You could see the wheels turning. Everybody was trying to think of every possible thing to save me." 

Sam, who had since become a nurse after being inspired by his father's earlier cancer journey, helped guide the family through the most difficult moments.  

"Mayo Clinic did a great job of individualizing our care and really being there for us as a family," says Sam. "They gave us all the time we needed to ask questions — I felt like there wasn't a time clock on any of our interactions." 

Mike's journey was precarious, and at several points, his survival remained uncertain. But through relentless determination — and the coordinated expertise of dozens of Mayo Clinic specialists — Mike made another extraordinary recovery.  

Survival fueled by resilience and expertise 

"That was one of the toughest cases of my life," says Dr. Shah of Mike's most recent hospitalization. "Him pulling through and walking out of the ICU was one of my most satisfying moments." 

One year later, Mike feels good. He has his strength back, is exercising and is almost back to 100%.  

"I shouldn’t be here. I threw so many rare situations at my care team, and each time, they saved my life," says Mike. "There's no way you can get expertise like this anywhere else. It's incredible." 

Sam is grateful for the time he spent with his dad throughout his healthcare journey. 

"My dad is resilient, strong and the bravest person I know," says Sam. "I could tell he was scared, but he would always say, 'I have to keep going. I have to keep listening to the doctors. I have to keep taking my medicine, and eventually I am going to get out of it.' And despite all the odds, he did it."  That mindset — paired with his multidisciplinary care team working together — helped transform what could have been an ending into an extraordinary comeback.

The post Against extraordinary odds: A life saved more than once appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — A major national cooperative group clinical trial led by Mayo Clinic researchers found that continuing maintenance therapy with lenalidomide beyond two years after initial treatment for standard-risk multiple myeloma did not improve overall survival compared with stopping treatment after two years. The findings, published in The New England Journal of Medicine, may help physicians and patients make more informed decisions about the duration of maintenance therapy.

"Longer treatment is often assumed to be better, but that's not always the case," says Shaji Kumar, M.D., a Mayo Clinic hematologist, the study's primary investigator. "As therapies become more effective, it's increasingly important to determine not only which treatments work, but also how long patients need them." The researchers say the findings may reduce treatment burden and lower the costs associated with years of ongoing therapy for many patients.

"Knowing that maintenance therapy can safely end after a defined period may help reduce the demands of long-term treatment for patients," says S. Vincent Rajkumar, M.D., a hematologist at Mayo Clinic and chair of the ECOG-ACRIN Cancer Research Group’s Myeloma Committee which spearheaded the trial. "These findings support informed, shared decision-making between physicians and patients."

New treatments for multiple myeloma over the past two decades have improved survival, and some patients now experience long-term disease control. The study applies specifically to patients with standard-risk multiple myeloma who did not receive an upfront stem cell transplant. Additional studies are underway to determine the optimal duration of maintenance therapy for patients with high-risk disease and to explore whether treatment duration can be tailored using measurable residual disease testing.

"This study reminds us that clinical trials shouldn't only focus on adding new therapies," Dr. Kumar says. "They should also help us understand when treatment can safely stop."

The trial was designed and conducted by the ECOG-ACRIN Cancer Research Group with support from the U.S. National Institutes of Health’s National Cancer Institute, through its National Clinical Trials Network. Amgen provided additional support.  

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Julie Ferris-Tillman, Ph.D., Mayo Clinic Communications, newsbureau@mayo.edu

The post Mayo Clinic-led study finds no improvement in overall survival from longer multiple myeloma maintenance therapy appeared first on Mayo Clinic News Network.

Bile duct cancer, also called cholangiocarcinoma, is rare, difficult to diagnose and often resistant to existing treatments. This episode of "Tomorrow's Cure" explores why researchers are pursuing new approaches, including an experimental platform that uses milk-derived nanoparticles to deliver gene therapy directly to cancer cells. 

In the episode, Rory Smoot, M.D., a hepatobiliary and pancreas surgeon at Mayo Clinic, explains that cholangiocarcinoma often develops without obvious symptoms until it reaches an advanced stage. Although researchers have made progress with targeted therapies and immunotherapy, many patients still have limited treatment options. 

"We're now starting the conversations with the FDA about next steps, because people have not made drugs out of milk before," Dr. Smoot says, describing the early-stage research.  

He explains that the naturally occurring nanoparticles found in milk could serve as a delivery vehicle for gene therapies designed to target cancer cells while sparing healthy tissue. Although the research remains in the clinical stage, researchers are now working to optimize gene targets and evaluate the approach across multiple forms of cholangiocarcinoma.   

The episode also features Melinda Bachini, chief patient officer for the Cholangiocarcinoma Foundation, who shares her experience as a stage 4 survivor after participating in an experimental clinical trial. Her story underscores both the promise of research and the patience required as potential new therapies move through clinical trials and the regulatory process. 

Looking ahead, Dr. Smoot envisions a future in which treatments are tailored to each patient's tumor. 

"In my perfect world ... it would be truly personalized care," he says, describing a potential approach that could match targeted therapies to the unique biology of a person's cancer. 

The conversation also highlights the growing role of artificial intelligence in accelerating cancer research, the importance of seeking care at experienced centers for rare cancers and the critical role patients play in advancing clinical research. 

Listen to the latest episode of "Tomorrow's Cure" wherever you get your podcasts. You can also explore the show's full library of episodes and guests on the show's playlist.  

The post Could milk-derived nanoparticles change bile duct cancer care?  appeared first on Mayo Clinic News Network.

Glioblastoma begins in glial cells, the brain's support cells. When these cells become cancerous, they can grow rapidly into surrounding tissue, damaging the healthy brain they were meant to protect. 

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"It tends to be a tumor that also tends to grow and invade the brain," says Dr. Alfredo Quinones-Hinojosa, Mayo Clinic neurosurgeon. "Sometimes it can be slow and steady, but it tends to grow very fast." 

Despite significant advances in surgery, chemotherapy, immunotherapy and radiation therapy, glioblastoma remains one of the most challenging cancers to treat. Long-term survival is uncommon. 

"The median survival of patients with the best therapies tends to be between 12 and 14 months," says Dr. Quinones-Hinojosa. 

Although there is no cure for glioblastoma, treatment can help slow tumor growth, manage symptoms and maintain quality of life. Ongoing research continues to advance understanding of the disease and create new possibilities for patients. 

"Research is crucial to finding hope and healing in every corner of our operating room, in every corner of our laboratory," says Dr. Quinones-Hinojosa. "We are connecting research and hope, ultimately, through our patients." 

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